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Background The objective of this systematic review and meta-analysis is to investigate whether nocturnal blood pressure fall, expressed by dipping patterns according to 24 h ambulatory blood pressure monitoring (ABPM), is associated with abnormal cognitive function (cognitive impairment or dementia). Methods We systematically searched PubMed, Embase, and Cochrane databases to identify original articles through December 2022. We included any study with at least ten participants reporting on all-cause dementia or cognitive impairment incidence (primary outcome) or validated cognitive tests (secondary outcome) among ABPM patterns. We assessed risk of bias using Newcastle–Ottawa Quality Assessment Scale. We pooled odds ratios (OR) and standardized mean differences (SMD) using random-effect models for primary and secondary outcome, respectively. Results In the qualitative synthesis, 28 studies examining 7595 patients were included. The pooled analysis of 18 studies showed that dippers had a 51% [OR 0.49(0.35–0.69)] lower risk of abnormal cognitive function and a 63% [OR 0.37(0.23–0.61)] lower risk of dementia alone, compared to non-dippers. Reverse dippers presented an up to sixfold higher risk [OR 6.06(3.15–11.64)] of abnormal cognitive function compared to dippers and an almost twofold higher risk [OR 1.81(1.26–2.6)] compared to non-dippers. Reverse dippers performed worse in global function neuropsychological tests compared with both dippers [SMD − 0.66(− 0.93 to − 0.39)] and non-dippers [SMD − 0.35(− 0.53 to − 0.16)]. Conclusion Dysregulation of the normal circadian BP rhythm, specifically non-dipping and reverse dipping is associated with abnormal cognitive function. Further studies are required to determine potential underlying mechanisms and possible prognostic or therapeutic implications. Protocol registration PROSPERO database (ID: CRD42022310384).

The incidence of cardiovascular disease is substantially increased in patients with type 1 diabetes compared to the general population. Robust evidence from the randomized Diabetes Control and Complications Trial (DCCT) and the long-term epidemiologic surveillance of its participants suggest that tight glycemic control by means of intensive insulin treatment is efficacious both in primary and secondary prevention of cardiovascular disease. New antidiabetic agents with proven cardiorenal benefit in patients with type 2 diabetes, such as Glucagen-Like Polypeptide-1 Receptor Agonists (GLP-1RA) and Sodium-Glucose co-Transporter-2 Inhibitors (SGLT-2inh), have been tested as adjunctive to insulin treatment in a few clinical trials in patients with type 1 diabetes. Despite their favorable effect on risk factors for atherosclerotic disease, such as body weight and blood pressure, the lack of evidence for a direct effect on cardiovascular outcomes and an increased risk for serious adverse events, such as diabetic ketoacidosis, limit their use in patients with type 1 diabetes. New metrics of glycemia, alterations in diabetes classification and precision medicine may contribute in an individualized approach of cardiovascular risk prevention in patients with diabetes.

Metformin has been for many years the first-line pharmaceutic treatment for most patients with type 2 diabetes. However, new classes of antidiabetic agents with proven cardiorenal benefits beyond glycemic control challenge metformin’s predominance. The hypoglycemic effect of metformin is mediated in liver by inhibiting gluconeogenesis and improving insulin sensitivity and in intestines by reducing glucose absorption, increasing incretins and altering intestinal microbiome. After decades of use metformin has been proved to be one of the most potent, safe and cost-effective medications for the treatment of type 2 diabetes. Several other pleiotropic actions of metformin in inflammation pathways suggest a potential cardioprotective role. This hypothesis has been tested in a few randomized trials and in more observational studies and metanalyses with controversial results. Given the lack of robust evidence for the cardioprotective effect of metformin compared to the newer antidiabetic agents, current treatment algorithms are under scrutiny. Ongoing randomized clinical trials comparing metformin to placebo are expected to elucidate the effect of metformin on specific cardiovascular and renal outcomes.

Patients with longstanding diabetes exhibit diminished nocturnal blood pressure (BP) drop, yet this phenomenon remains understudied in the early stages of the disease. Eighty patients with newly diagnosed (

Primary aldosteronism (PA) is associated with considerably higher cardiovascular risk and increased prevalence of organ damage compared to essential hypertension (EH). Laser speckle contrast imaging (LSCI) has emerged as a novel non-invasive tool to assess of skin microcirculation. Our aim was to evaluate skin microvascular function (SMF) using LSCI coupled with post-occlusive reactive hyperemia (PORH) in a group of PA patients (PAs) compared to patients with EH (EHs) and normotensive controls (NTs). We enrolled PAs, age- and gender-matched with EHs and NTs. All participants underwent SMF assessment by LSCI with PORH. We enrolled 109 participants including 29 PAs, 47 EHs, and 33 NTs. SMF was significantly impaired in PAs, including peak time (p

Patients with longstanding diabetes exhibit diminished nocturnal blood pressure (BP) drop, yet this phenomenon remains understudied in the early stages of the disease. Eighty patients with newly diagnosed (6 months) Diabetes Mellitus type 2 (T2DM) and 80 non-T2DM individuals underwent office and 24-h ambulatory BP measurements, estimation of hemodynamic parameters using impedance cardiography and blood tests. Ten-year atherosclerotic cardiovascular disease (ASCVD) risk score was calculated. T2DM patients exhibited higher nighttime systolic blood pressure (SBP) (p = 0.028) and lower dipping (p 0.001) compared to controls. In the total population, dipping correlated negatively with age, HbA

Objective Menopausal transition has been associated with an increased risk of cardiovascular disease (CVD), mainly attributed to atherogenic dyslipidaemia, central obesity and insulin resistance. Whether arterial hypertension (AH) also contributes to menopause-associated CVD is currently unknown. The aim of this study was to systematically investigate and meta-analyze the best available evidence regarding the association between early menopause (EM) and AH risk. Methods A comprehensive search was conducted in PubMed, CENTRAL and Scopus databases, up to January 20th, 2020. Data were expressed as odds ratio (OR) with 95 % confidence intervals (CI). The I2 index was employed for heterogeneity. Results Ten studies were included in the quantitative analysis (273,994 postmenopausal women, 76853 cases with AH). Women with EM (age at menopause 45 years) (OR 1.10, 95 % CI 1.01–1.19, p = 0.03; I2 79 %). The direction or the magnitude of this association remained significant when the analysis was restricted to studies including groups matched for potential confounders, such as age, BMI, smoking or the use of menopausal hormone therapy or oral contraceptives. Conclusions Women with EM have an increased risk for AH compared with those of normal age at menopause.

Background: This research attempts to determine the needs of the physiotherapy graduates and the needs emerge when they start their career as professionals. Furthermore, the importance of the creation of a supporting program is being investigated, which will assist graduates and specially those who are interested in working in the field of pediatric physiotherapy. The program will provide solutions to graduates for practicalpsychological issues, which might arise in the first steps of their career and will provide solid guidance and incident handling. Material and methods:92 physiotherapists participated in the study. Those are employed in private physiotherapy centers, public hospitals, school for special needs, recovery centershome-based therapy in Thessaloniki area. The data was collected by using questionnaires during the months of October 2018 to January 2019. Results:Descriptive analysis and exploratory factoring methods were applied for the statistical processing, which resulted in the conclusion that there is a need to support and guide the new physiotherapy graduates, so that they can integrate smoothly into their new professional life and have a successful career. The views of physiotherapists are not affected by their various demographic characteristics. Conclusions: It is necessary to guide the new physiotherapy graduates in general and more particularly in pediatric physiotherapy, through a tutor-based supporting program. keywords : Pediatric Physiotherapy, Tutor-based Supporting program, Mentor